Paget's Disease of the Breast

October is Breast Cancer Awareness Month, and to celebrate… yes celebrate… increased awareness, which leads to earlier detection and therefore more cures, I’m going to tell you the sad story of a woman whose breast cancer ended her life way too early. But in her honor and for your benefit, I’ll share with you her scripted final message to help all women.

The lady in this story developed a rash on her breast. Because her mammogram was normal, her doctor treated her with antibiotics for a presumed infection. After two courses of different antibiotics, it continued to get worse, so her doctor sent her for another mammogram. That time it was diagnosed as a fast growing breast cancer called Paget’s Disease of the Breast.

She underwent chemotherapy , then a mastectomy, then more chemo, and finally radiation. After nine months of intense treatment, she was given a clean bill of health. But tragically, a year later, her cancer recurred in her liver. She had four more chemo treatments, to no avail, and then made the incredibly brave decision that she wanted quality of life, not quantity, and so discontinued her chemo as she knew its side effects. She lived five great months and planned each detail of the final days before she died. And she left this message to be delivered to women everywhere:

“Women, please be alert to anything that is not normal. If you think something isn’t right, it’s probably not, and be persistent in getting help as soon as possible.”

You may have never heard of Paget’s Disease of the Breast, but it actually accounts for almost 5% of all cases of breast cancer. It almost always starts as a rash on only one breast involving either the nipple or the surrounding flat area, the areola. The rash is usually itchy, may tingle, cause increased sensitivity, or even burning or pain. And there can even be a discharge from the nipple. There is also redness and mild scaling and flaking of the nipple or areola. Because early on it often waxes and wanes and appears to improve on its own, diagnosis is often delayed because it lulls you into thinking it’s just a mild rash and not serious.

But more than 95 percent of patients with Paget’s Disease also have underlying invasive breast cancer… or at least non invasive, which is completely curable. That’s why early diagnosis is life saving. The woman whose story I told you knew that, which is why she relayed her message.

While most patients diagnosed with Paget Disease are over age 50, rare cases have been diagnosed in patients as young as in their 20s. In my practice, I see many women with breast rashes and I am very aggressive in making an early definitive diagnosis so there is no delay when the diagnosis turns out to be Paget’s.

If you have an itchy, red, or flaky nipple or areola rash, see your gynecologist or your dermatologist, immediately. That action may save your life.

And please share this message or episode with your friends or family, because it just may save theirs.

In honor of Breast Cancer Awareness Month, Dr. Schultz discusses a skin disease that tends to be a precursor to breast cancer.